Combined Phacoemulsification and Ahmed Glaucoma Drainage

Implant Surgery

Leonidas Traipe, M.D.Felipe Valenzuela, M.D.Carlos Nieme, M.DJuan Stoppel, M.D.Allister Gibbons, M.D.Mario Zanolli, M.D.

Fundación Oftalmológica Los Andes (FOLA), Santiago, Chile

The authors have no financial interest in the subject matter of this poster

Introduction

• Glaucoma drainage implants are specially indicated when the risks of failure with conventional trabeculectomy are high

NVG, uveitic glaucoma, etc.

• When cataract and glaucoma coexist together in a patient with refractory glaucoma, critical management issues arise

Selection of the optimum glaucoma surgical procedure, sequence of surgery, etc

• This procedure offers theoretical advantages like: Avoid the high risk of failure associated with conventional filtering surgery Improved IOP control in the long term and good visual rehabilitation Less risk of blebitis – endophtalmitis Single surgical procedure

Purpose

• To examine the indications, safety, efficacy and complications of combined phacoemulsification and Ahmed glaucoma drainage implant surgery.

Methods• Noncomparative, interventional, retrospective, consecutive

case series of 24 eyes (21 patients).• 1 surgeon (LT)

Demographic characteristics Indications Visual Acuity Complications

IOP and antiglaucoma medications : Complete success IOP < 21mmHg w/o medications Qualified success IOP < 21mmHg with medications Failure IOP > 21mmHg +/- medications

• Approved by FOLA Ethics Comittee • Statistical Analysis was performed using SPSS 16.0

Results: Demographic characteristics

N° of Eyes 24

N° of Patients 21

Age 61 ± 19 y (13-91 y)

Female / Male 1.6 / 1

Follow-up 15.9 ± 13 mo

INDICATIONS n % Reports**

Previous failed trabeculectomy*

13 54 47 – 48 %

Neovascular Glaucoma 2 8 3 – 22 %

Uveitic Glaucoma 5 21 16 %

Post-Trauma 1 4 3 %

Iridocorneal Endothelial Sd 0 - 9 %

Chronic Angle-Closure Glaucoma 0 - 3 – 6 %

Blebitis / Leaking filtering bleb 0 - 3 – 12 %

Post Keratoplasty 0 - 3 %

Post Scleral Buckle 0 - 6 %

* 7 eyes -> 1 previous surgery / 5 eyes -> 2 previous surgeries / 1 eye -> 3 previous surgeries

**Hoffman et al. Combined Cataract Extraction and Baerveldt Glaucoma Drainage Implant . Ophthalmology 2002**Chung et al. Surgical Outcomes of Combined Phacoemulsification and Glaucoma Drainage Implant Surgery for Asian Patients With Refractory Glaucoma With Cataract. Am J Ophthalmol 2004

Visual Acuity FOLAPre Postop

20/40 – 20/20 21% 54%

20/50 – 20/100 25% 23%

< 20/100 54% 23%

Visual Acuity

Mean VA Preop 20/400 (HM to 20/30) Postop 20/80 (CF to 20/20)

Improved 79% (19), Maintened 21% (5) p < 0.0001

IOP (mmHg)

Mean ± SD Range

Preop 27,6 ± 11 8 a 45

Postop* 16,3 ± 4 7 a 20↓ 41%

* IOP at last visit p < 0.0001

Antiglaucoma Medications

Mean Range

Preop 3,2 ± 0,83 1 to 4

Postop 1,3 ± 1,1 0 to 3↓ 60 %

N° of antiglaucoma medications

p < 0.0001

Overall Outcome

n %

Success 8 33.3

Qualified Success 16 66.6

Failure 0 -

1. Complete success IOP < 21mmHg w/o medications 2. Qualified success IOP < 21mmHg with medications 3. Failure IOP > 21mmHg +/- medications

COMPLICATIONS n % Reports**

Early

Hipotony 2 8 19%

Shallow AC 2 8 6%

Choroideal effusion 4 16 6%

Tube Oclussion 0 - 3%

Hiphema 1 4 3%

Late

Tube Retraction 1 4 3%

Hypertensive phase 11 46 22%

Tube Exposure 0 - 3%

Iritis 0 - 3%

Corneal decompensation 0 - 6-9%

**Hoffman et al. Combined Cataract Extraction and Baerveldt Glaucoma Drainage Implant . Ophthalmology 2002**Chung et al. Surgical Outcomes of Combined Phacoemulsification and Glaucoma Drainage Implant Surgery for Asian Patients With Refractory Glaucoma With Cataract. Am J Ophthalmol 2004

Conclusions

• Combined phacoemulsification and Ahmed glaucoma drainage implant placement seems to be a safe and effective surgical option, providing good visual rehabilitation and control of IOP, with low incidence of complications.